Country Focus: Swaziland's Unexpected Success Tackling Paediatric HIV

Khanyisile Mavimbela took her first HIV test when she was in her late twenties, unmarried and pregnant. Shocked when the results came back positive, she worried she would infect her baby with the virus. altShe felt scared and alone, and didn’t know where to turn for help.
Khanyisile’s story is all too common in Swaziland, a small landlocked kingdom nestled next to the Lumbombo Mountains and bordered by South Africa and Mozambique. The country’s unfortunate claim to fame is that it has the highest rate of HIV in the world.
One in four adults in Swaziland are reported to be HIV-positive. More women are infected than men and an incredible 41 percent of pregnant women carry the virus.
For a country facing such daunting statistics, Swaziland has made surprising progress in tackling mother-to-child transmission of HIV. It is considered one of the countries that has the potential of reaching the United Nation’s Global Plan goal of eliminating paediatric HIV by 2015. One of the primary reasons is that Swaziland integrated its PMTCT (prevention of mother-to-child transmission) programme into its prenatal care facilities when it was launched in 2003, making HIV testing an essential part of maternal care. There are now PMTCT programmes at 88 percent of the country’s health facilities.
This has contributed to a high proportion of pregnant women being tested for HIV – more than 80 percent by the end of 2010. The number of HIV-positive pregnant women who received antiretroviral drugs (ARVs) to reduce the risk of transmitting the virus to their babies has also grown substantially — from 4 percent in 2004 to an estimated 95 percent in 2011. Widespread use of testing and treatment is starting to have an impact on Swaziland’s paediatric HIV rate. In 2011, 15.4 percent of infants born to HIV-positive mothers were infected with HIV, down 3 percent from 2010.
mothers2mothers (m2m) was initially invited by the Ministry of Health to open sites in Swaziland in 2008 with the support of UNICEF, as the Health Minister himself had seen how m2m’s peer education and psychosocial counselling were helping women access and stay in care in neighbouring South Africa. m2m is currently the only programme in Swaziland providing mentoring services to pregnant women living with HIV. With 60 sites located across all four regions of the country, our programmes reach an average of 2000 HIV-positive women every month.
It was m2m’s Mentor Mothers who helped Khanyisile come to terms with her diagnosis and disclose her status to her mother. “When I was pregnant, my CD4 count was so low that I had to start treatment there and then. I was worried about being HIV-positive and starting treatment at the same time. It was difficult,” she says. But Khanyisile goes onto to explain how the Mentor Mothers helped her understand the importance of adhering to treatment to stay alive, and keep her baby healthy. “I trusted them. The way they told me their own stories, they created a bond between me and themselves. I wanted to try what they were saying.”
Today, Khanyisile has not one, but two daughters who are HIV-negative, and she is a Site Coordinator for mothers2mothers at the Tikhuba Clinic, located in a rural area of Swaziland near the Mozambican border. Khanyisile says it’s very rare these days that a child is born HIV-positive at her clinic. She says there were only three babies born positive last year, less than half the number in previous years.
Catroina Maovihera, a nurse at Tikhuba Clinic, credits mothers2mothers with helping reduce paediatric HIV infections and improving maternal health at the clinic. “It’s much easier for the mothers to divulge their concerns, their challenges, with the Mentor Mothers compared to the nurses,” she says. “Sometimes they feel that we’re just too formal, or they feel that they take too much time from the nurse. But with the Mentor Mothers, they get these one-on-one sessions where they are able to divulge as much as they need to, they are able to share whatever they need to with them because they have all that time to do it,” she adds.
mothers2mothers is working with Swaziland’s Ministry of Health to fulfill the goals of the UN Global Plan, and with Site Coordinators like Khanyisile bringing her story of success to the mothers of Swaziland, we are getting closer to making paediatric HIV a thing of the past.